Provider Demographics
NPI:1265408306
Name:BENJAMIN, KELLANGE J (CRNA)
Entity type:Individual
Prefix:MS
First Name:KELLANGE
Middle Name:J
Last Name:BENJAMIN
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Gender:F
Credentials:CRNA
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Mailing Address - Street 1:3601 W COMMERCIAL BLVD
Mailing Address - Street 2:ANESCO NORTH BROWARD LLC STE 4-5
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3300
Mailing Address - Country:US
Mailing Address - Phone:954-485-5666
Mailing Address - Fax:954-485-1651
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:BROWARD GENERAL MEDICAL CENTER
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-355-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2017-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP3110862367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307120100Medicaid
FLG3811ZMedicare PIN